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Saturday, June 14, 2014

A PVC Ain't Always a Pipe

Ever feel like there might be two small cats scrapping it out inside your chest, thumping and bumping and rolling around, making you feel as though someone has a little syringe of adrenaline and is popping you with it every few seconds so that you get that anxious feeling of being suddenly startled into a feeling of impeding doom? 
There’s a name for what causes that disconcerting sensation: premature ventricular contractions, or PVCs. Even the name is unsettling. They started tormenting me about two weeks ago, and I immediately knew what they were. You see, I’ve had them before and taken medicine to stop them. Cardiologists call them runs of PVCs. I call them a waking nightmare. Try to imagine feeling really frightened for fifteen or twenty minutes at a time. It’s distracting and eventually leads to undue fatigue. Who gets tired just sitting at a keyboard and tapping the keys? It happened to me, and, believe me, for a while there, it was difficult to transfer my thoughts to the page.  

Okay. Let’s back up. I've had atrial fibrillation (A-fib) for about five years. It's a condition which causes irregular heartbeats that are generated in one of the upper chambers of the heart, the right atrium, as opposed to those that come from the ventricles, the lower chambers of the heart. Sometimes the medicine used to control A-fib can control ventricular premature beats. God! You didn't sign up for nursing school, did you? So, enough already. You get it. I have a history of rhythm problems in my heart. 

When this bout with premature beats started, they lasted only a minute or two, and having experienced them before, I knew to take an extra dose of the medicine that can hold them at bay. At first it worked. They went away. Then they came back - and lasted ten or fifteen minutes. So, I called my cardiologist in Macon to ask for a referral to a heart specialist in Brunswick, which is only five miles from my apartment via causeway. The nurse was no help. Rather than make me an appointment with someone near me, she chose instead to bitch me out because I missed my EKG appointment at their office last year. Some of you may remember that just about this time last year, Parrish attempted suicide for the first time. I was a little tied up. Then we moved. A one-eyed monkey could understand why I missed the appointment. Not only was I not symptomatic, I had other things on my mind.

Never mind that. I took it upon myself to call a reputable heart specialist in Brunswick. Scheduling the appointment turned out to be an orgy of miscommunication and phone tag. A less refined person than I would call it a cluster-fuck. I phoned the office and left a message with the appointment person. She called me back two days later, but I wasn’t home. Since it was after five o’clock on Friday afternoon when I received the message, I couldn’t return the call until the following Monday. When I did get through to her, the appointment person claimed she didn’t understand that I was having a problem. Believe me, the message I left with was not vague, but that is neither here nor there. 

When I explained to her what was going on, she scheduled me to be seem the next morning at seven-thirty. Still not seeming to understand that I was symptomatic and wanted help right away, she also offered me an afternoon appointment later in the week - in case I’m not a morning person. Seriously. I grabbed the seven-thirty. Where do these people come from?

I took extra medicine the night before the appointment and again that morning because I was having runs of PVCs that were lasting not minutes but hours. I was “in rhythm” when the nurse did my EKG, and I remained so throughout the echocardiogram they performed that morning. An echocardiogram is a sonogram of the heart which is diagnostic for decreased blood flow or a heart valve problem. Shit, I'm doing it again - lecturing. My echo' was normal, and I came away unscathed except for a hematoma the size of a silver dollar on my arm where the nurse tried to inject me with contrast medium. Medical people are cursed when it comes to health care. If it can go wrong, it will go wrong for nurses, doctors and their families. I’m used to it.

I left the office with a sheet of instructions and an appointment for a stress test in two days.

Not wanting to miss even a moment of art class, I dropped off P at the apartment and drove directly to the studio, where I finished my first painting since grade school. (It’s a still life of oranges and lemons in a bowl. What else?) Then I went home to get P, and we took Honey to day care at Puppy Paradise and went to lunch. Two bites into my cheeseburger, there it was: bu-thump, bu-thump, bu-thump. Great. My new doctor, like my other one, advised me to take an extra Betapace when symptoms appeared, so, ever the compliant patient, I had taken along an extra pill for just such an occasion. I popped it into my mouth, expecting everything to be better in a little while.

We ate. We went to Winn-Dixie and milled around in there for a while, and the beats just kept on coming. (Sorry. That just slipped out.) I dropped P at our apartment with the groceries and drove to fetch Honey. It was a few minutes after five when we got home, and my chest was still thuh-bumping. 

I was exhausted, took another pill. Remember that four hours had passed since lunch, and I was still out of rhythm.

When I got no relief from the extra Betapace, and my symptoms became worse, I, at Parrish's insistence, I drove to urgent care, where again my EKG was normal. But, the nurse there kept me on the monitor, and within two minutes, the dreaded PVCs showed their ugly faces - every other beat, every third beat, painting a graph of steep hills and crashing valleys across the screen. While we waited for the doctor to finish his coffee, Ella, the nurse, regaled me with her husband's A-fib story.

He’s a Merchant Marine and went into A-fib while at sea working long hours in an engine room. He was flown back to the mainland, where doctors tried to no avail to convert his rhythm back to normal. A couple of days into his treatment, he wanted to have sex with his wife. She demurred, but he insisted that if it killed him, he would at least die happy. When they were done, he was in regular rhythm and has remained so since, which bears out my late husband’s belief that sex is the treatment of choice for anything that ails you. Too bad I don’t have a lover.

Back to my story…

The arrhythmia continued in spectacular fashion…and the doctor came into the room and clucked over me. I was surprised when he didn't wring his hands. He, of course, insisted I go to the hospital, and he denied my request to drive myself. Hell, I had been driving myself around for days. I had seen a cardiologist that morning, and he didn't tell me not to drive. 

Parrish did well during this time of uncertainty. His fears can be unreasonable, which is normal for him, but he remained as calm as he could under the circumstances. The urgent care folks put me in an ambulance, and Lawrence drove over here to gather up P and Honey and meet me at the ER.

For an hour after I arrived, my heart was wildly out of rhythm. Then it converted to normal. The doctor, an adolescent who didn't look old enough to drive, kept me for two more hours and let me come home. On the way, the damned extra beats returned, and I had to take extra medicine - again. The next day was a long, marked by hours-long stretches of arrhythmia and its attendant chest fullness and fatigue.

The next afternoon, I returned to the doctor’s office for a stress test. It went well. My blood pressure responded normally to the stress and the test revealed no blockages. Yea! There were, however, plenty of PVCs, the first documented at the doctor’s office. Afterward, plagued with a headache, I was so out of rhythm that the technician had to reset the imaging machine to accommodate the irregularity. I left the office wearing a heart monitor and I was symptomatic the for rest of the day, through art class and up until bedtime - in spite of extra medicine.

I returned the monitor this Monday morning and have not yet heard from the MD’s office. My follow-up appointment is in three weeks, and not being willing to wait that long for some relief, I doubled my medication. The heart doc advised me to take extra if I needed it, so rather than wait for the PVCs to start, I'm taking a proactive approach to my own health care and comfort. Don't worry. I'm not all that stupid. I researched the maximum dosage of Betapace, and I'm taking a reasonable amount.

It took a couple of days, but I am back in rhythm, going to Music Night and walking. In this era of healthcare, when one has to be dying to get much attention, it's essential to thoughtfully make decisions for ourselves. 
No, I'm not advocating the abandonment of a doctor's care. If not for my cardiologists, I wouldn't have the medicine I need. My doctor would be treating me aggressively if he thought I were in danger. It's just that my symptoms, though not lethal, are mine, not his. I wish, for just thirty minutes, those cats would romp around inside his chest. I wish he had to work through that kind of distraction. I believe he would be more eager to treat unsettling symptoms in his patients, whether or not they are life-threatening. 

Any thoughts?

copyright 2014
cj Schlottman

1 comment:

tmhighsmith said...

That sounds awful! Like a constant anxiety attack. Has no one suggested a pacemaker to regulate? Maybe a trip back to Macon or Emory? Not impressed with your care.I love you